ABOUT THE SPEAKER

Ivan Oransky - Health reporter
Ivan Oransky is the executive editor of Reuters Health, and has done pioneering work in covering scientific retractions.

Why you should listen

Ivan Oransky is a doctor-turned reporter. With an MD and an internship completed, he left to cover heath and health care, bringing the insight of a trained doctor to the beat. He is now executive editor of Reuters Health, and also teaches journalism and medicine at New York University.

He is also the co-founder of Retraction Watch a blog that tracks and investigates retractions in scientific journals, and it's sister-site, Embargo Watch, doing the same for reporting on scientific papers.

More profile about the speaker
Ivan Oransky | Speaker | TED.com

TEDMED 2012

Ivan Oransky: Are we over-medicalized?

Ivan Oransky: 我們都被過度醫藥化了嗎？

Filmed: 2012-04-11

697,753 views

路透社記者Ivan Oransky警告我們正面臨一個充斥著診斷前兆、高危險群…等名詞的環境中，而且日趨嚴重。在這個TEDMED的演講中，Ivan Oransky告訴我們可以如何透過棒球的道理來找出醫療照護的解決之道。

Ivan Oransky - Health reporter
Ivan Oransky is the executive editor of Reuters Health, and has done pioneering work in covering scientific retractions. Full bio

Double-click the English transcript below to play the video.

00:16

Those of you who have seen看到 the film電影 "Moneyball點球成金,"

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在場看過電影「魔球」

00:20

or have read讀 the book書 by Michael邁克爾 Lewis劉易斯,

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或者看過麥可．路易斯書的人

00:22

will be familiar熟 with the story故事 of Billy比利 Beane比恩.

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對比利．比恩的故事並不陌生吧

00:25

Billy比利 was supposed應該 to be a tremendous巨大 ballplayer球壇; all the scouts偵察兵 told him so.

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所有的球探都告訴比利他原本會是個傑出的球員

00:29

They told his parents父母 that

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他們告訴他的父母

00:31

they predicted預料到的 that he was going to be a star星.

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他們預測比利將成為明日之星

00:33

But what actually其實 happened發生 when he signed簽 the contract合同 -- and by the way, he didn't

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但當他簽了合約後的事實是－

00:38

want to sign標誌 that contract合同, he wanted to go to
college學院 --

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順帶一提，他並不想要簽那個合約，他想上大學

00:40

which哪一個 is what my mother母親, who actually其實 does
love me,

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這就是為什麼愛我的媽媽

00:43

said that I should do too, and I did --

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說我也應該去上大學，然後我去了－

00:46

well, he didn't do very well. He struggled掙扎
mightily強烈地.

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嗯…他沒有做得很好，而且做得非常辛苦。

00:49

He got traded交易 a couple一對 of times時, he ended結束 up in the Minors未成年人 for most最 of his career事業,

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他被交易了幾次，他的職業生涯大多在小聯盟裡

00:53

and he actually其實 ended結束 up in management管理. He ended結束 up as a General一般 Manager經理 of the

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最終他成為了球隊經理

00:57

Oakland奧克蘭 A's如.

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他擔任了奧克蘭運動家隊的的經理

00:58

Now for many許多 of you in this room房間, ending結尾 up in management管理, which哪一個 is also也 what I've doneDONE,

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回到在座的各位來說，和我一樣以管理階層的身份離開

01:02

is seen看到 as a success成功.

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被認為是成功的

01:04

I can assure保證 you that for a kid孩子 trying試 to make it in the Bigs大個子,

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我能向你保證對於那些想打進大聯盟的孩子們來說

01:07

going into management管理 ain't不 no success成功 story故事. It's a failure失敗.

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進入到管理階層並不是成功的故事，那是失敗。

01:12

And what I want to talk to you about today今天, and share分享 with you, is that our

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而我今天想跟你們分享的是

01:16

healthcare衛生保健 system系統, our medical醫 system系統, is
just as bad壞 at predicting預測

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我們的保健、醫藥系統

01:21

what happens發生 to people in it -- patients耐心,
others其他 --

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對於預測人們或是病人發生了什麼事

01:25

as those scouts偵察兵 were at predicting預測 what would happen發生 to Billy比利 Beane比恩.

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就和球探們預測比利．比恩的未來一樣不準

01:30

And yet然而, every一切 day

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然後，每一天

01:32

thousands數千 of people in this country國家

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這個國家裡有成千上萬的人

01:34

are diagnosed確診 with preconditions先決條件.

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被診斷出生病的前兆

01:38

We hear聽 about pre-hypertension高血壓前期, we hear聽 about pre-dementia前癡呆,

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我們到到有高血壓的前兆、痴呆的前兆

01:42

we hear聽 about pre-anxiety前焦慮, and I'm pretty漂亮 sure that I diagnosed確診 myself我 with

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焦慮症的前兆
我非常確定在那個綠色的房間裡

01:48

that in the green綠色 room房間.

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我認為我患了焦慮症

01:49

We also也 refer參考 to subclinical亞 conditions條件.

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我們也被暗示有症狀不顯著的病症

01:53

There's subclinical亞 atherosclerosis動脈粥樣硬化, subclinical亞 hardening硬化 of the arteries動脈,

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可能是症狀不顯著的動脈粥樣硬化、動脈硬化

01:58

obviously明顯 linked關聯 to heart心 attacks攻擊, potentially可能.

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明顯地被聯結為潛在的心臟病

02:02

One of my favorites最愛 is called叫
subclinical亞 acne粉刺.

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我最愛的一種稱為症狀不顯著的粉刺

02:05

If you look up subclinical亞 acne粉刺, you may可能 find a website網站, which哪一個 I did,

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如果你查詢這個症狀，你會和我一樣發現一個網站

02:09

which哪一個 says說 that this is the easiest最簡單的 type類型 of acne粉刺 to treat對待.

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裡頭提到了這是最容易治療的粉刺種類

02:13

You don't have the pustules膿皰 or the redness發紅 and inflammation炎.

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你沒有膿皰、紅腫或發炎

02:20

Maybe that's because you don't actually其實
have acne粉刺.

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或許這是因為你其實根本就沒有粉刺

02:23

I have a name名稱 for all of these conditions條件, it's another另一個 precondition前提:

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我為這些病症取了一個名字，這又是另一個前兆了：

02:30

I call them preposterous荒謬.

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我稱它為荒唐病

02:32

In baseball棒球, the game遊戲 follows如下 the pre-game賽前.

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在棒球裡，正式比賽在熱身賽之後

02:38

Season季節 follows如下 the pre-season季前.

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球季在賽前季之後

02:40

But with a lot of these conditions條件, that actually其實 isn't the case案件, or at least最小 it isn't the

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但是在許多情況中根本不會有病

02:45

case案件 all the time. It's as if there's a rain雨 delay延遲, every一切 single單 time in many許多 cases例.

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至少是大部份的時候都不會有病
那就好像隨時隨地都有遇雨停賽的可能

02:49

We have pre-cancerous癌前病變 lesions病變,

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我們有癌症的徵兆

02:51

which哪一個 often經常 don't turn轉 into cancer癌症.

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但是最終通常都不會變成癌症

02:55

And yet然而,

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還有

02:56

if you take, for example例, subclinical亞
osteoporosis骨質疏鬆, a bone骨 thinning細化 disease疾病,

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以症狀不顯著的骨質疏鬆症為例

03:00

the precondition前提,

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這是一種骨質薄化的病症

03:02

otherwise除此以外 known已知 as osteopenia骨質疏鬆,

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如果你將它視為骨質減少

03:04

you would have to treat對待 270
women婦女 for three三 years年份

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你必須在三年內治療270位女性

03:08

in order訂購 to prevent避免 one broken破碎 bone骨.

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以免其中一位跌斷了骨頭

03:10

That's an awful可怕 lot of women婦女

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當你計算有多少女性

03:12

when you multiply乘 by the number數 of women婦女
who were diagnosed確診

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被診斷為骨質減少時
所得到的數字

03:15

with this osteopenia骨質疏鬆.

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將會非常驚人

03:17

And so is it any wonder奇蹟,

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是否有人懷疑過

03:19

given特定 all of the costs成本 and the side側 effects效果

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花費這些錢

03:21

of the drugs毒品 that we're using運用 to treat對待 these preconditions先決條件, that every一切 year年

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還有為了治療這些徵兆而服用的藥物所帶來的副作用

03:25

we're spending開支 more than two trillion兆 dollars美元 on healthcare衛生保健 and yet然而

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我們已在健康管理上花費超過兩萬億美元

03:29

100,000 people a year年 -- and that's a conservative保守 estimate估計 -- are dying垂死

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而且保守估計每年還有十萬人面臨死亡

03:32

not because of the conditions條件 they have,

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他們不是因為有了什麼疾病

03:34

but because of the treatments治療 that we're giving給 them and the complications並發症 of those treatments治療?

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而是因為我們給他的治療所產生的併發症
讓他面臨死亡

03:39

We've我們已經 medicalized用醫學方法 everything

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在這個國家

03:41

in this country國家.

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我們一直用醫藥的方式來處理每件事

03:42

Women婦女 in the audience聽眾, I have
some

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在場的女性朋友

03:46

pretty漂亮 bad壞 news新聞 that you already已經 know,

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有幾個壞消息是您已經知道的

03:48

and that's that every一切 aspect方面 of your
life

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那就是您生命中的每一個面向

03:50

has been medicalized用醫學方法.

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都已被醫藥化了

03:52

Strike罷工 one is when you hit擊中 puberty青春期.

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第一個階段是在你年輕的時候

03:54

You now have something that happens發生 to you once一旦 a month月 that has been medicalized用醫學方法.

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有一個東西是每個月出現一次
那也已經被醫藥化了

03:59

It's a condition條件;

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這是一種已經被治療的症狀

03:59

it has to be treated治療. Strike罷工 two

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第二個階段是

04:01

is if you get pregnant孕.

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如果你懷孕了

04:03

That's been medicalized用醫學方法 as
well.

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這件事也被醫藥化了

04:06

You have to have a high-tech高科技 experience經驗

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你必須要經歷高科技的懷孕過程

04:08

of pregnancy懷孕, otherwise除此以外 something might威力 go wrong錯誤.

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否則可能會有問題

04:10

Strike罷工 three三 is menopause絕經.

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第三個階段是更年期

04:14

We all know what happened發生 when millions百萬 of women婦女 were given特定 hormone激素 replacement替代 therapy治療

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我們都知道幾十年來上百萬位婦女

04:18

for menopausal更年期 symptoms症狀

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被以荷爾蒙替代療法來治療更年期的症狀

04:21

for decades幾十年 until直到 all of a sudden突然 we realized實現, because a study研究 came來了 out, a big大 one,

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直到某一刻國家衛生研究所發表了一篇研究

04:26

NIH-fundedNIH資助.

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我們才突然驚醒

04:27

It said,

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這份研究報告指出

04:28

actually其實, a lot of that hormone激素 replacement替代 therapy治療 may可能 be doing more harm危害 than good

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事實上，對許多婦女來說

04:32

for many許多 of those women婦女.

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荷爾蒙替代療法可能造成更多的傷害

04:34

Just in case案件,

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遠多於它所帶來的幫助

04:36

I don't want to leave離開 the men男人 out --

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比方說

04:38

I am one, after all --

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我不想讓男人離開

04:40

I have really bad壞 news新聞 for all of you in
this room房間,

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畢竟我也是個男人

04:42

and for everyone大家

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我有一個壞消息要告訴在座的男性

04:43

listening聽 and watching觀看 elsewhere別處:

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以及在任何地方的觀眾朋友

04:45

You all have

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你們都有

04:46

a universally舉世 fatal致命 condition條件.

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致命的病症

04:49

So, just take a moment時刻.

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因此，請深呼吸片刻

04:52

It's called叫 pre-death預死亡.

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這叫作死亡前兆

04:54

Every一切 single單 one of you has it, because
you have the risk風險 factor因子 for it,

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每一個人都有這個病症
因為你們都有一個可能致死的危險因子

04:59

which哪一個 is being存在 alive活.

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那就是活著

05:01

But I have some good news新聞 for you,
because

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但是我有一個好消息要告訴你

05:04

I'm a journalist記者, I like to end結束 things in a happy快樂 way or a forward-thinking前瞻思維 way.

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因為我是個新聞工作者
我喜歡讓事情以快樂或是正向思考的方式來作結

05:08

And that good news新聞 is that if you can survive生存 to the end結束 of my talk, which哪一個

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這個好消息是如果你能夠在我的演講後倖存

05:12

we'll好 see if that happens發生 for everyone大家,

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稍後見分曉

05:14

you will be a pre-vivor預vivor.

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你就會是一位有「倖存前兆」的人

05:17

I made製作 up pre-death預死亡.

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我虛構了死亡前兆這個詞

05:22

If I used someone有人 else's別人的 pre-death預死亡, I apologize道歉,

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如果我用了某個人創造的這個詞

05:26

I think I made製作 it up.

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如有雷同，純屬巧合

05:28

I didn't make up pre-vivor預vivor.

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我並沒有虛構倖存前兆者

05:30

Pre-vivor預vivor is what a particular特定 cancer癌症 advocacy擁護 group組 would like everyone大家 who

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倖存前兆者是一個多麼特殊的癌症提倡團體

05:35

just has a risk風險 factor因子,

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希望每個人都有危險因子

05:36

but hasn't有沒有 actually其實 had that cancer癌症,

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但是事實上

05:39

to call themselves他們自己.

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他們連這個癌症的名字都沒有

05:40

You are a pre-vivor預vivor.

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你是一個倖存前兆者

05:42

We've我們已經 had HBOHBO here this morning早上. I'm wondering想知道 if Mark標記 Burnett伯內特 is anywhere隨地 in the

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我們今早在這裡看了HBO電影台

05:46

audience聽眾, I'd like to suggest建議

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我很好奇如果馬克伯內特在場

05:48

a reality現實 TV電視 show顯示 called叫 "Pre-vivor預vivor."

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我會建議他拍一場叫「倖存前兆者」的實鏡電視秀

05:52

If you develop發展 a disease疾病, you're off
the island島.

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如果你生了病，你就得離開這座島

05:55

But the problem問題 is, we have a system系統

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但是問題是

06:01

that is completely全然 --

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我們有一種非常徹底且基本的宣傳機制

06:02

basically基本上 promoted提拔 this.

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我們是被選出來的

06:04

We've我們已經 selected選, at every一切 point點 in this system系統,

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在這個機制的每一分一毫都被安排好了

06:07

to do what we do, and to give everyone大家 a
precondition前提 and then eventually終於

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我們要做的事、給每個人一個前兆

06:11

a condition條件, in some cases例.

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接著其中一部份則成了病症

06:13

Start開始 with the doctor-patient醫患
relationship關係. Doctors醫生, most最 of them,

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以醫病關係來作說明

06:18

are in a fee-for-service服務費 system系統. They are
basically基本上 incentivized誘因 to do more --

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大部份的醫生都在收費服務的機制裡

06:23

procedures程序, tests測試,

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基本上他們樂於做更多手續、測驗

06:24

prescribe規定 medications藥物治療.

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開立處方箋

06:26

Patients耐心 come to them,

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病人前來就醫

06:27

they want to do something. We're
Americans美國人, we can't just stand站

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他們想要某種東西
我們是美國人，我們不會只是站在那裡

06:31

there, we have to do something. And so
they want a drug藥物.

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我們需要做點什麼
因此他們得到了藥物與治療

06:34

They want a treatment治療. They want to be told, this is what you have and this is how

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他們想要聽到這是你目前可以用的藥
以及你如何治療病症

06:38

you treat對待 it. If the doctor醫生
doesn't give you that,

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如果醫生沒有給你這些東西

06:40

you go somewhere某處 else其他.

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你就會另外找一家醫院

06:42

That's not very good for doctors'醫生
business商業.

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這對醫生的生意來說不太好

06:44

Or even worse更差,

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更糟的可能是

06:46

if you are diagnosed確診 with something
eventually終於, and the doctor醫生 didn't order訂購 that test測試,

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如果最後你被診斷出某種疾病

06:50

you get sued起訴.

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而之前的醫生沒有做那些檢驗，你就會告他

06:52

We have pharmaceutical製藥 companies公司 that are
constantly經常 trying試 to expand擴大

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我們有不斷嘗試開發出適用各種病症藥品的製藥廠

06:55

the indications適應症, expand擴大 the number數 of people who are eligible合格 for a given特定 treatment治療,

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擴展能夠得到合適處方藥物的病人

07:00

because that obviously明顯 helps幫助 their其 bottom底部 line線.
We have advocacy擁護 groups組,

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因為那很顯然的滿足了最基本的需求

07:03

like the one that's come up with
pre-vivor預vivor,

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我們有像「倖存前兆者」的提倡團體

07:05

who want to make more and more people feel they are at risk風險, or might威力 have a condition條件,

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試著想要讓更多人覺得他們身處危機、患有病症

07:10

so that they can raise提高 more funds資金

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因此他們可以得到更多的贊助

07:12

and raise提高 visibility能見度, et等 cetera等等.

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提升能見度等等

07:14

But this isn't actually其實,

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然而這並非屬實

07:16

despite儘管 what journalists記者 typically一般 do,
this isn't actually其實 about blaming歸咎

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不管新聞工作者怎麼做

07:19

particular特定 players玩家.

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都不是在責備特別的球員

07:21

We are all responsible主管.

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我們都很盡責

07:22

I'm responsible主管.

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我也很盡責

07:24

I actually其實 root根 for the Yankees洋基, I mean talk
about

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其實我支持洋基隊

07:27

rooting生根 for the worst最差
possible可能

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我的意思是當你可以做任何事情的時候

07:30

offender犯罪分子 when it comes來 to doing
everything you can do.

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支持最有可能的罪犯

07:33

Thank you.

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謝謝

07:34

But everyone大家 is responsible主管.

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但是每個人都是負責任的

07:38

I went去 to medical醫 school學校,

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我曾去過醫學院

07:41

and I didn't have a course課程 called叫 How to Think Skeptically懷疑地,

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卻沒有一堂叫做「如何保持懷疑態度的思考」

07:46

or How Not to Order訂購 Tests測試.

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或是「如何避免做檢驗」

07:48

We have this system系統

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我們的體制如此

07:50

where that's what you do.

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而你只能在其中做該做的事

07:53

And it actually其實 took拿 being存在 a journalist記者

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這其實讓身為記者的我了解所有這些動機

07:55

to understand理解 all these incentives獎勵. You know, economists經濟學家 like to say,

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你知道經濟學者可能會說

07:59

there are no bad壞 people,

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世界上沒有不好的人

08:00

there are just bad壞 incentives獎勵.

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只有不好的動機

08:02

And that's actually其實 true真正.

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確實如此

08:04

Because what we've我們已經 created創建 is a sort分類 of Field領域 of Dreams夢, when it comes來 to medical醫 technology技術.

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因為我們創造了一種醫學界的《夢幻成真》

08:07

So when you put another另一個 MRIMRI in
every一切 corner角, you put a robot機器人

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當你在每一個角落擺一台核磁共振儀器

08:13

in every一切 hospital醫院 saying話 that everyone大家 has to have robotic機器人 surgery手術.

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就等於你在每一間醫院放了一個機器人
他會告訴每個人都需要機器手術

08:16

Well, we've我們已經 created創建 a system系統 where if you
build建立 it, they will come.

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我們已經建立了一個機制
一旦建立了，事情就會順其而行

08:20

But you can actually其實 perversely倒行逆施

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但是你也可以倔將地告訴人們

08:24

tell people to come, convince說服 them

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說服他們

08:26

that they have to come.

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一定要這麼做

08:28

It was when I became成為 a journalist記者 that I really realized實現 how I was part部分 of this problem問題,

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一直到我當了記者後
我才理解到原來我也是問題的一部份

08:33

and how we all are part部分 of this problem問題.

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而且我們大家都是這個問題的一部份

08:35

I was medicalizingmedicalizing every一切 risk風險 factor因子, I was writing寫作 stories故事, commissioning試運行 stories故事,

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過去我醫藥化每一個風險因子

08:39

every一切 day, that were trying試 to,

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我每天都寫了很多故事且授權故事

08:42

not necessarily一定 make people worried擔心, although雖然 that was what often經常 happened發生.

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目的是不讓人們感到如此焦慮
雖然這種事很常發生

08:45

But, you know, there are ways方法 out.

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但是你知道
事情總有解決的辦法

08:48

I saw my own擁有 internist內科醫生 last week週,

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上個星期我去見了我的內科醫生

08:50

and he said to me,

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他告訴我

08:52

"You know," and he told me something that

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「你知道的，你該減肥了。」

08:55

everyone大家 in this audience聽眾 could have
told me for free自由,

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每一個在場的觀眾都可以免費告訴我這件事

08:57

but I paid支付 him for the privilege特權, which哪一個
is that

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但是我卻得花錢請他跟我說

09:00

I need to lose失去 some weight重量.

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那就是我該減肥了

09:02

Well, he's right. I've had honest-to-goodness誠實，善良 high高 blood血液 pressure壓力

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好吧，他是對的

09:06

for a dozen打 years年份 now, same相同

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我確實是好幾十年的高血壓患者

09:08

age年齡 my father父親 got it,

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我父親在我這個年紀的時候也一樣

09:09

and it's a real真實 disease疾病. It's not pre-hypertension高血壓前期, it's actual實際

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而且這是一個真的疾病，這不是前兆而已

09:13

hypertension高血壓, high高 blood血液 pressure壓力.

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1973

這是真的高血壓

09:15

Well, he's right,

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985

好吧，他是對的

09:16

but he didn't say to me,

184

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但是他沒有告訴我

09:19

well, you have pre-obesity預肥胖 or

185

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嘿，你有肥胖的前兆

09:21

you have pre-diabetes糖尿病前期, or anything like that. He didn't say,

186

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3345

或是你糖尿病的前兆，或是那之類的病症
他一點也沒有說

09:24

better start開始 taking服用 this Statin他汀類藥物, you need to lower降低 your cholesterol膽固醇.

187

548908

3376

他用了一個比較好的方式告訴我
你該減少你的膽固醇攝取量

09:28

No, he said, "Go out and lose失去 some weight重量. Come back and see me in a bit位,

188

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喔，不對，
他是說：「出門去減個肥吧！之後再來和我見面

09:31

or just give me a call and let me know how you're doing."

189

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2001

還是打個電話通知我，讓我知道你已經開始減肥了

09:33

So that's, to me,

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對我來說

09:35

a way forward前鋒.

191

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這是一條可行的路

09:37

Billy比利 Beane比恩, by the way, learned學到了 the same相同
thing.

192

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順帶一提

09:39

He learned學到了,

193

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比利．比恩也學到了同樣的道理

09:40

from watching觀看 this kid孩子 who he eventually終於 hired僱用, who was really successful成功 for him,

194

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他終於僱用了這個孩子，而這個孩子也真的成功了

09:44

that it wasn't不 swinging擺盪 for the fences圍欄, it
wasn't不 swinging擺盪 at every一切 pitch瀝青

195

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他在這之中學到了並不只是要打出全壘打

09:49

like the sluggers重擊手 do, which哪一個 is what all the expensive昂貴 teams球隊 like the Yankees洋基 like to --

196

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不是每一球都要像打擊率高的選手一樣每球必中
這就和洋基隊那種熱門球隊的作法一樣

09:54

they like to pick挑 up those guys.

197

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他們喜歡挑選那樣的人

09:55

This kid孩子 told him, you know, you gotta總得 watch the guys, and you gotta總得 go out and find

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這個孩子告訴他，你要好好觀察這些人

10:00

the guys who like to walk步行,

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然後找出一個喜歡走路的人

10:01

because getting得到 on base基礎 by a walk步行

200

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因為步行上壘是件好事

10:02

is just as good, and in our healthcare衛生保健
system系統

201

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而在我們的醫藥體系中

10:05

we need to figure數字 out,

202

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我們需要認出

10:07

is that really a good pitch瀝青

203

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這是真的好球嗎？

10:08

or should we let it go by and not swing搖擺 at everything?

204

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還是就此遺忘，別理這件事？

10:11

Thanks謝謝.

205

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謝謝

Translated by Marssi Draw
Reviewed by Yuguo Zhang

ABOUT THE SPEAKER

Ivan Oransky - Health reporter
Ivan Oransky is the executive editor of Reuters Health, and has done pioneering work in covering scientific retractions.

Why you should listen

Ivan Oransky is a doctor-turned reporter. With an MD and an internship completed, he left to cover heath and health care, bringing the insight of a trained doctor to the beat. He is now executive editor of Reuters Health, and also teaches journalism and medicine at New York University.

He is also the co-founder of Retraction Watch a blog that tracks and investigates retractions in scientific journals, and it's sister-site, Embargo Watch, doing the same for reporting on scientific papers.

More profile about the speaker
Ivan Oransky | Speaker | TED.com

THE ORIGINAL VIDEO ON TED.COM

Ivan Oransky: 我們都被過度醫藥化了嗎？ | TED Talk | TED.com